Provider Demographics
NPI:1376029280
Name:JACKSON, DEBRA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8183 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7441
Mailing Address - Country:US
Mailing Address - Phone:724-480-2402
Mailing Address - Fax:
Practice Address - Street 1:8183 KIPLING ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7441
Practice Address - Country:US
Practice Address - Phone:724-480-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty